631 Study Guide

OSHAcademy
Course 631 Study Guide

Copyright 2000-2014 Geigle Safety Group, Inc.
Hospital Hazards and
Solutions:
Surgical Suite

OSHAcademy


Copyright 2000-2014 Geigle Safety Group, Inc. Page 2 of 21
OSHAcademy Course 631 Study Guide
Hospital Hazards and Solutions: Surgical Suite
Copyright 2014 Geigle Safety Group, Inc.
No portion of this text may be reprinted for other than personal use. Any commercial use of
this document is strictly forbidden.
Contact OSHAcademy to arrange for use as a training document.
This study guide is designed to be reviewed off-line as a tool for preparation to successfully
complete OSHAcademy Course 631.
Read each module, answer the quiz questions, and submit the quiz questions online through
the course webpage. You can print the post-quiz response screen which will contain the correct
answers to the questions.
The final exam will consist of questions developed from the course content and module quizzes.
We hope you enjoy the course and if you have any questions, feel free to email or call:
OSHAcademy
1915 NW Amberglen Parkway, Suite 400
Beaverton, Oregon 97006
www.oshatrain.org
instructor@oshatrain.org
+1.888.668.9079

Disclaimer
This document does not constitute legal advice. Consult with your own company counsel for advice on compliance with all applicable state and
federal regulations. Neither Geigle Safety Group, Inc., nor any of its employees, subcontractors, consultants, committees, or other assignees
make any warranty or representation, either express or implied, with respect to the accuracy, completeness, or usefulness of the information
contained herein, or assume any liability or responsibility for any use, or the results of such use, of any information or process disclosed in this
publication. GEIGLE SAFETY GROUP, INC., DISCLAIMS ALL OTHER WARRANTIES EXPRESS OR IMPLIED INCLUDING, WITHOUT LIMITATION, ANY
WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. Taking actions suggested in this document does not guarantee
that an employer, employee, operator or contractor will be in compliance with applicable regulations. Ultimately every company is responsible
for determining the applicability of the information in this document to its own operations. Each employers safety management system will be
different. Mapping safety and environmental management policies, procedures, or operations using this document does not guarantee
compliance regulatory requirements.

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Contents
Course Introduction ........................................................................................................................ 5
Module 1: Surgical Suite Hazards .................................................................................................. 6
Dangerous Waste Gases ............................................................................................................. 6
Exposure Hazards ........................................................................................................................ 6
Bloodborne Pathogens ............................................................................................................... 7
Sharps Injuries ............................................................................................................................. 8
Latex Allergies ............................................................................................................................. 9
Static and Awkward Postures ................................................................................................... 10
Module 1 Quiz ........................................................................................................................... 11
Module 2: Other Hazards ............................................................................................................. 12
Compressed Gases ................................................................................................................ 12
Smoke Plume ........................................................................................................................ 12
Hazardous Chemicals ................................................................................................................ 13
Equipment Hazards ................................................................................................................... 14
Slips, Trips, and Falls ................................................................................................................. 14
Module 2 Quiz ........................................................................................................................... 16
Module 3: Laser Usage in a Surgical Suite ................................................................................... 17
Introduction .............................................................................................................................. 17
Laser Classifications .................................................................................................................. 17
Class 1 ................................................................................................................................... 17
Class 1M ................................................................................................................................ 17
Class 2 ................................................................................................................................... 17
Class 2M ................................................................................................................................ 17
Class 3R ................................................................................................................................. 18
Class 3B ................................................................................................................................. 18
Class 4 ................................................................................................................................... 18
Safety Issues .............................................................................................................................. 18
Training ..................................................................................................................................... 19
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Credentialing ............................................................................................................................. 19
Module 3 Quiz ........................................................................................................................... 20
Endnotes ....................................................................................................................................... 21

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Course Introduction
Doctors and nurses who work in the surgical suite have to
deal with several different types of hazards, including
waste gases and hazardous chemicals.
This course is geared towards the employee and will
provide some possible solutions to protect you against
the various hazards that are present in a surgical suite.
Once you complete this course, you will have knowledge
of the following components:
dangerous waste gases
sharps injuries
static and awkward postures
smoke plume
hazardous chemicals
medical laser classifications

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Module 1: Surgical Suite Hazards
The anesthetic gases and vapors which leak into the
surrounding room during medical procedures are
considered waste anesthetic gases. It is estimated
that more than 250,000 health care professionals
who work in hospitals, operating rooms, dental
offices and veterinary clinics, are potentially
exposed to waste anesthetic gases and are at risk of
occupational illness.
Dangerous Waste Gases
The waste anesthetic gases and vapors of concern include the following:
nitrous oxide
halogenated agents (vapors)
o halothane
o enflurane
o isoflurane
o desflurane
Some potential effects of exposure to waste anesthetic gases are:
nausea
dizziness
headaches
fatigue
irritability
sterility
miscarriages
birth defects
cancer
liver and kidney disease among operating room staff
Employers and employees should be aware of the potential effects
and be advised to take appropriate precautions.
Exposure Hazards
Many health care workers are unaware of the potential health
hazards associated with waste anesthetic gases in their work
environment. This makes them more vulnerable to illness.
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Potential Hazards
Workers could be exposed to waste anesthetic gases from:
poor work practices during the anesthetization of patients
leaking or poor gas-line connections
improper or inadequate maintenance of the machine
patient exhalation in the recovery room or Post Anesthesia Care Unit (PACU) during off-
gassing of surgery patients
Possible Solutions
Employers should use an anesthetic gas finding system in operating rooms. An appropriate
waste gas evacuation involves collecting and removing waste gases, detecting and correcting
leaks, considering work practices, and effectively ventilating the room.
There also needs to be enough ventilation in the surgical suite to keep the room concentration
of waste anesthetic gases below the applicable occupational exposure levels. To minimize
waste anesthetic gas concentrations in the operating room, the recommended air exchange
rate (room dilution ventilation) is a minimum total of 15 air changes per hour with a minimum
of 3 air changes of outdoor air (fresh air) per hour.
When using a properly designed and operating dilution ventilation system, it will minimize
waste anesthetic gas concentrations in recovery room areas. The system should provide a
recommended minimum total of 6 air changes per hour with a minimum of 2 air changes of
outdoor air per hour.
OSHA also recommends the following when dealing with anesthesia gases and machines:
Vaporizers of anesthesia machines should be turned off when not in use. Proper face
masks, sufficiently inflated endotracheal tubes, and the prevention of anesthetic spills
will decrease the amount of waste anesthetic gases in the operating room.
Inspection and maintenance of anesthesia machines should be conducted by factory
service representatives or other qualified personnel at least every four months.
Prior to each day's use, a complete check of all anesthesia equipment (connectors,
tubing, etc.) should be conducted.
Spills of liquid anesthetic agents should be cleaned up promptly.
Bloodborne Pathogens
Potential Hazards
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Occupational exposure to blood and other potential infectious material (OPIM) puts surgical
room employees at risk of infection from bloodborne pathogens while performing surgery-
related tasks. These include:
Hepatitis B Virus
Hepatitis C Virus
Human Immunodeficiency Virus (HIV)
Possible Solutions
Among other things, OSHA's Bloodborne Pathogens Standard requires that:
Engineering and work practice controls be used to eliminate or minimize exposures to
blood and OPIM.
Sharps Injuries
In addition, sharps injuries in the surgical area must be
eliminated or minimized through use of measures such as:
Using safer needle/other sharps devices.
Using blunt-tip suture needles.
Using needleless IV connectors.
Providing proper containers for sharps.
Perform a "No Pass Zone" for surgical instruments
You should have a method for passing equipment
safely between surgeon and assistants.
o The hands-free technique is a work practice
whereby a tray or other means are used to
eliminate simultaneous handling of sharp
instruments during surgery.
Appropriate personal protective equipment (PPE) must be worn if blood or OPIM
exposure is anticipated. The type of PPE depends on the anticipated exposure.
Appropriate PPE includes, but is not limited to, gloves, gowns, face shields or masks, and
shoe covers. For example:
o Gloves must be worn when hand contact with blood, mucous membranes, OPIM, or
non-intact skin is anticipated, or when handling contaminated items or surfaces.
o Masks, in combination with eye protection devices, must be worn whenever
splashes, spray, splatter or droplets of blood or OPIM may be generated.
Contaminated needles and other contaminated sharps be discarded immediately or as
soon as feasible into appropriate containers.
Sharps containers must be located close to the area where sharps are used or could be
found.
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Contaminated needles and other contaminated sharps must not be bent, recapped, or
removed. Shearing or breaking contaminated needles is prohibited.
Employers must make sure hand washing facilities be readily accessible and require
employees to wash their hands immediately or as soon as feasible after removal of
gloves or other personal protective equipment.
o Hands must be washed with an appropriate soap and water, whenever there has
been occupational exposure to blood or OPIM. If a sink is not readily accessible (e.g.,
in the field) in instances where there has been occupational exposure, hands may be
decontaminated with hand cleanser or towelette, but must be washed with soap
and running water as soon as feasible.
o If there has been no occupational exposure to blood or OPIM, use of an appropriate
antiseptic hand cleanser is acceptable.
For more information on bloodborne pathogens in the healthcare setting, please click here.
Latex Allergies
Allergy to latex was first recognized in the late 1970s. Since
then, it has become a major health concern as an increased
number of people in the workplace are affected. Health
care workers exposed to latex gloves or medical products
containing latex are especially at risk. It is estimated that 8-
12% of health care workers are latex sensitive.
Potential Hazard
Developing latex allergy from exposure to products that contain latex such as gloves,
catheters, and tubing.
Possible Solutions
Provide appropriate gloves, including powder-less, hypoallergenic, glove liners, or other
similar alternatives to employees who are allergic to the gloves normally provided.
Note: Do not assume hypoallergenic gloves are non-latex or latex-free.
In addition, good work practices should be used. These may include:
providing a latex-safe work environment
using non-latex gloves and other latex-free products
selecting a low protein, powder-free glove
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Static and Awkward Postures
Medical staff in a surgical setting often assume prolonged awkward postures. Typically,
employees vary in height which may require work surfaces at differing heights to minimize
awkward postures.
Potential Hazards
Standing in static postures continuously during lengthy surgical procedures causes
muscle fatigue and pooling of blood in the lower extremities.
Standing on hard work surfaces such as concrete creates trauma and pain to the feet.
Awkward postures resulting from prolonged standing, trunk flexion, neck flexion, and
arms held higher than the optimal working height.
Possible Solutions
Provide stools, where possible.
Use shoes with well-cushioned insteps and soles.
Provide a footrest bar or a low stool, allowing employees to continually alter their
posture by raising one foot.
Use height-adjustable work tables and surfaces.
Use anti-fatigue mats.

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Module 1 Quiz
Use this quiz to self-check your understanding of the module content. You can also go online
and take this quiz within the module. The online quiz provides the correct answer once
submitted.
1. Which of the following is/are potential effects of exposure to waste anesthetic gases?
a. nausea
b. fainting
c. irritability
d. both A and C are correct
2. Why are health care workers more vulnerable to illness when it comes to waste anesthetic
gases?
a. They are not trained
b. They are unaware of the health hazards
c. They are careless
d. They do not wear the proper personal protective equipment
3. It is estimated that _____ of health care workers are latex sensitive.
a. 5-10%
b. 8-12%
c. 15-20%
d. 1-3%
4. John is a surgical assistant and works for a local community hospital. He is required to put
on latex gloves before performing surgery. What is this an example of?
a. Engineering control
b. Work practice control
c. Common sense
d. Administrative control
5. Which of the following is a possible solution to static and awkward positions in a surgical
suite?
a. Use shoes with well-cushioned insteps
b. Do not work for extended periods of time
c. Take numerous breaks
d. Work somewhere else in the hospital
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Module 2: Other Hazards
Compressed Gases
Within a healthcare facility, compressed gases are usually
either fixed piped gas systems or individual cylinders of
gases.
Potential Hazards
Hazards with compressed gas varies based on the
chemicals.
o May include fire, explosion, and toxicity.
Possible Solutions
Store, handle, and use compressed gases in accordance
with 29 CFR 1910.101.
All cylinders, whether empty or full, must be stored
upright.
Secure cylinders of compressed gases. Cylinders should
never be dropped or allowed to strike each other with
force.
Transport compressed gas cylinders with protective caps in place and do not roll or drag
the cylinders.
Smoke Plume
Laser or electrosurgical units may be required during surgical procedures. Smoke byproduct or
"plume" is created when tissue is thermally destroyed. Smoke plume may contain toxic gases
and vapors such as:
benzene
hydrogen cyanide and formaldehyde
bio aerosols
dead and live cellular material (including blood fragments)
viruses
The research is limited on transmission of disease
through surgical smoke, but the potential for
generating infectious viral fragments, particularly
during treatment of venereal warts, may exist.
Researchers have suggested the smoke may act as a
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vector for cancerous cells which may be inhaled by the surgical team and other exposed
individuals.
Potential Hazards
Exposure to high concentrations of smoke may cause ocular and upper respiratory tract
irritation and create visual problems for the perioperative team.
Smoke may contain toxic gases that could have the potential for adverse health impacts,
such as mutagenic and carcinogenic impacts.
Possible Solutions
Use portable smoke evacuators and room suction systems with inline filters.
Keep the smoke evacuator or room suction hose nozzle inlet within 2 inches of the
surgical site to effectively capture airborne contaminants.
Have a smoke evacuator available for every operating room where plume is generated.
Evacuate all smoke, no matter how much is generated.
Keep smoke evacuator "ON" (activated) at all times when airborne particles are
produced during all surgical or other procedures.
Consider all tubing, filters, and absorbers as infectious waste and dispose of them
appropriately. Use Universal Precautions as required by the OSHA Bloodborne
Pathogens Standard when contaminated with blood or OPIM.
Use new tubing before each procedure and replace the smoke evacuator filter as
recommended by the manufacturer.
Inspect smoke evacuator systems regularly to ensure proper functioning.
Hazardous Chemicals
Potential Hazards
Employees can be exposed to possible hazardous chemicals found and used in the surgical area
typically during mixing, preparation, and in the operating room. These may include:
peracetic acid used in cold sterilant machines
Methyl Methacrylate (MMA)
an acrylic cement-like substance used to secure prostheses to bone during orthopedic
surgery waste anesthetic gases
Possible Solutions
Mix methyl methacrylate only in a closed system.
Carefully read and follow instructions and warnings on labels, (e.g., when using cold
sterilant machines for sterilizating equipment that cannot be autoclaved, use goggles
provided and do not open machine until it is in a safe to open mode).
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Consider using disinfectants or other products that are not hazardous.
Inform employees of chemical hazards and have on hand Material Safety Data Sheets,
(MSDS) for all hazardous chemicals used in their facilities.
Follow all MSDS instructions regarding safe handling, storage, and disposal of hazardous
chemicals.
Equipment Hazards
Potential Hazard
Surgical employees can be exposed to burns or
shocks from poorly maintained equipment (e.g.,
autoclaves, warming cabinets, defibrillators).
Possible Solutions
Employers should create a safety and health program to
monitor the condition of equipment and address work
practices of employees. This program should include
practices such as:
Train employees to correctly and safely use and clean equipment.
Maintain adequate working space and access to equipment.
Visually inspect equipment before using.
o Visually inspect cords and do not use if frayed or damaged.
o If something does not look right, do NOT use the machine and call for assistance.
Ensure that all electrical service equipment near sources of water are properly grounded
[29 CFR 1910.304].
Use appropriate personal protective equipment and safe work practices for assessed
hazards (e.g., when handling hot items use gloves, and do not open autoclaves or
sterilizers until items are sufficiently cooled).
Adhere to all manufacturer and operator instructions to ensure safe use of equipment.
Slips, Trips, and Falls
Potential Hazards
falling over portable equipment of a color that visually blends into the floor
slipping on debris (bandages, tubing, blood, IV fluids) that had fallen or spilled on the
floor
tripping on electrical cords that may cross floors
Possible Solutions
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Keep all places of employment clean, orderly, and in a sanitary condition [29 CFR
1910.22(a)(1)].
Keep aisles and passageways clear and in good repair, with no obstructions across or in
aisles that may create a hazard [29 CFR 1910.22(b)(1)].
Provide ceiling or floor outlets for equipment to ensure that power cords do not run
across pathways.
Mark mobile equipment (e.g., stools) with a bright color, or a taped "X", making them
more visible and distinguishable from the floor. Tape should be washable and durable.

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Module 2 Quiz
submitted.
1. The potential hazard associated with compressed gas includes _____.
a. gas leak
b. explosions
c. death
d. nausea
2. When is a smoke plume created?
a. When there is an excess of anesthetic gases
b. When there is too much smoke in the surgical area
c. When tissue is thermally destroyed
d. When equipment fails
3. Keep smoke evacuator OFF at all times when airborne particles are produced during all
surgical or other procedures.
a. True
b. False
4. When can employees be exposed to possible hazardous chemicals found and used in the
surgical area?
a. During mixing
b. During preparation
c. Always
d. Both A and B are correct
5. Surgical employees can be exposed to burns or shocks from _____.
a. lack of training
b. poorly maintained equipment
c. carelessness
d. hazardous chemicals

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Module 3: Laser Usage in a Surgical Suite
Introduction
Although there are hundreds of different types of lasers, only about a dozen laser systems are
found in everyday clinical use. Employees are exposed to lasers used in healthcare facilities
during diagnostic, cosmetic, preventive, and therapeutic applications. Nearly all laser products
used in surgery are Class 4. They are designed to deliver laser radiation for the purpose of
altering biological tissue.
Laser Classifications
Federal regulations require manufacturers to classify medical laser systems based primarily on
their ability to cause damage to the eye and skin. This classification must be indicated on the
laser systems label.
Lets now take a look at the various types of laser classifications.
Class 1
A Class 1 laser system is considered to be incapable of producing damaging radiation levels
during normal operations. This system is also exempt from any control measures or other
forms of surveillance. Although some Class 1 laser systems emit very weak, non-hazardous
beams, most incorporate embedded higher-power lasers. These lasers can only be accessed
if important safety features, such as interlocks, are defeated or deliberately bypassed.
Class 1M
A Class 1M laser system is also considered incapable of producing
damaging radiation levels during normal operations unless the
beam is viewed with an optical instrument, such as a telescope.
Class 2
A Class 2 laser system emits in the visible portion of the spectrum.
Eye protection normally occurs with an aversion response, such as
the closure of the eyelid, eye movement, or movement of the head
to avoid an exposure to a bright light. The aversion response to a
bright visible laser source limits the exposure of the retina to .25
seconds or less.
Class 2M
A Class 2M laser system emits in the visible portion of the spectrum. Eye protection normally
occurs with an aversion response for unaided viewing. However, viewing the beam with optical
aids is potentially hazardous.
Class 2 and higher lasers
must have the laser
radiation warning label.
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Class 3R
A Class 3R laser system is potentially hazardous under some direct and shiny or mirror-like
viewing conditions if the eye is focused and stable. The probability of an actual injury is small.
This laser will not pose either a fire hazard or diffuse reflection hazard.
Class 3B
A Class 3B laser system may be hazardous under direct and specular viewing conditions, but is
normally not a diffuse reflection or fire hazard.
Class 4
A Class 4 laser system is a hazard to the eye and skin from the direct beam, and may pose a
diffuse reflection or fire hazard. This type of laser system may also produce laser-generated
airborne contaminants and hazardous plasma radiation.
Safety Issues
When lasers are introduced into a healthcare environment, professionals must be prepared to
address safety issues for both the staff and patient. Safe use of these systems requires an
understanding of the engineering, training, and administrative requirements for all elements of
a healthcare system as well as the risks associated with use of laser light.
All medical lasers are regulated and federal regulations require manufacturers to classify the
medical laser system based primarily on its ability to cause damage to the eye and skin. This
classification must be indicated on the laser systems label ranging from Class 1 (no hazard) to
Class 4 (serious hazard).
Potential Hazards
severe eye injuries from direct or reflected laser beams
skin burns from the direct beam of surgical lasers when misdirected
respiratory hazards when breathing laser-generated airborne contaminants (LGAC)
Possible Solutions
The American National Standard Institute (ANSI) Z136 series of laser safety standards covers
lasers in medical settings and provides guidance for the safe use of lasers in healthcare
facilities. These guidelines are considered to be the standard for safe practice in the industry
and include solutions such as:
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Use laser protective eyewear that provides adequate protection against the specific
laser wavelengths being used. All laser eyewear must be marked with Optical Density
(OD) and laser wavelength.
Display warning signs conspicuously on
all doors entering the Laser Treatment
Controlled Area (LTCA) to warn those
entering the area of laser use. Warning
signs should be covered or removed
when the laser is not in use.
Facility-authorized technicians who are
trained in laser service must perform
maintenance on lasers and laser systems.
Provide local exhaust ventilation with a smoke evacuator or a suction system with an in-
line filter to reduce laser-generated airborne contaminants (LGAC) levels in laser
applications.
Use an appropriate filter or barrier which reduces any transmitted laser radiation to
levels below the applicable Maximum Permissible Exposure (MPE) level, for all facility
windows (exterior or interior) or entryways located within the Nominal Hazard Zone
(NHZ) of a Class 3B and Class 4 laser system.
Use skin protection if repeated exposures are anticipated at exposure levels at or near
the applicable MPE limits for the skin.
Training
Detailed training in laser safety should be provided for those healthcare personnel using, or
working in the presence of Class 3B and Class 4 health care laser systems. All training activities
should be documented and retained on file. Laser safety training should be presented to the
following healthcare personnel:
1. Laser Safety Officer (LSO)
2. users
3. laser technical support staff
4. nurses and allied health personnel
Credentialing
Each medical specialty has evolved its own procedures for bringing in new techniques and new
surgical procedures. In all cases, the laser user should use the laser for its intended purpose
within the user's scope of practice, training and experience. All credentialing processes must
require training in the safe clinical use of the laser, as well as the maintenance of a safe
environment in compliance with defined standards, and local, state and federal requirements.

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Module 3 Quiz
submitted.
1. Nearly all laser products used in surgery are _____.
a. Class 3R
b. Class 1M
c. Class 4
d. Class 2
2. Eye protection normally occurs with an aversion response, such as the closure of the
eyelid, in which type of laser?
a. Class 2
b. Class 3M
c. Class 1
d. Class 4
3. A _____ laser system is potentially hazardous under some direct and shiny viewing
conditions.
a. Class 1
b. Class 4
c. Class 1M
d. Class 3R
4. All laser training activities should be documented and retained on file.
a. True
b. False
5. Class 2 and higher lasers must have a _____.
a. laser radiation warning label
b. usage requirements
c. protective cover
d. training aspect

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Endnotes
1. Occupational Safety and Health Administration. (2014). Use of Medical Lasers. Retrieved
from: https://www.osha.gov/SLTC/etools/hospital/surgical/lasers.html
2. Occupational Safety and Health Administration. (2014a). Latex Allergy. Retrieved from:
https://www.osha.gov/SLTC/latexallergy/index.html
3. Occupational Safety and Health Administration. (2014b). Waste Anesthetic Gases. Retrieved
from: https://www.osha.gov/SLTC/wasteanestheticgases/
4. Occupational Safety and Health Administration. (2014c). Surgical Suite. Retrieved from:
https://www.osha.gov/SLTC/etools/hospital/surgical/surgical.html

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